Couples in New York state who are struggling to get pregnant might be able to save money on fertility treatments, thanks to a new law enacted in the 2020 state budget. It requires some large group insurance plans to cover in vitro fertilization (IVF). It also requires insurance carriers of all sizes to cover medically necessary fertility preservation—i.e. egg freezing for women with cancer or other illnesses.
Want to know if you’ll be covered? We asked Betsy Campbell, chief engagement officer at RESOLVE: The National Infertility Association, to answer all of your biggest questions about the new law. The gist? “It updates New York’s insurance law, so that cost is no longer a barrier to effective treatment for millions of New Yorkers.”
Who is covered under the new law?
The IVF law helps people who have health insurance from a New York–based employer that has a fully insured large group plan with 100+ employees. Approximately half of New Yorkers with health insurance would be able to receive the benefit, according to a report by the state’s Department of Financial Services.
The medically necessary fertility preservation coverage is required in all commercial insurance plans in the large group, small group and individual markets in New York.
How do I find out if my insurance plan qualifies?
For IVF, ask your employer these three questions:
- Is the health insurance controlled by NY state? (The policy is usually written/resides in the state where the company is headquartered.)
- Is the health insurance fully insured? (Plans that are self-insured are exempt from state law.)
- Is your employer part of the large group market with 100+ employees?
If the answer is yes to all three questions, then your plan must cover IVF. Medically necessary fertility preservation will be required in all commercial insurance plans in the large group, small group and individual markets in New York. If you are not covered by this new law, visit resolve.org for resources to help ask your employer about coverage options.
How is infertility defined according to the law?
It’s a disease or condition characterized by the incapacity to impregnate another person or to conceive, which is defined by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or therapeutic donor insemination, or after six months of regular, unprotected sexual intercourse or therapeutic donor insemination for a woman 35 years or older. Earlier evaluation and treatment may be warranted based on an individual’s medical history or physical findings.
What procedures are included? Is there a cap on coverage?
Three IVF cycles are now covered (IUI or artificial insemination was already covered) as well as standard fertility preservation procedures for people facing iatrogenic or medically induced infertility, that is, infertility caused by a medical intervention, such as radiation, medication or surgery.
What’s defined as medically necessary egg freezing?
Medically necessary egg freezing is for cancer patients and others facing iatrogenic or medically induced infertility.
How many rounds of IVF are covered?
Approximately how many people will be impacted by the new law?
The new law covers 2.5 million people for IVF insurance (large group market) and 4.7 million for medically necessary fertility preservation (individual, small and large group markets).
Is surrogacy covered under the plan?
No, compensated gestational surrogacy is still banned in New York, but RESOLVE is continuing to work on passing the Child-Parent Security Act, which would overturn this.
Will medium and small group insurers ever gain coverage?
We are still working to expand coverage to all markets through further legislation.
How about single women? And gay and lesbian couples?
Single women and lesbian couples who need IVF are covered.
Does a person have to live in New York, or work in New York, to receive the benefits?
No, the employee does not have to live or work in New York if the employer’s health insurance plan is controlled by New York state, meaning the policy was written/resides in the state, which is usually where the company is headquartered.
What if someone is covered under their spouse or partner’s insurance?
Then they are covered as well.
Ten other states require IVF coverage (11 total). Seven other states require fertility preservation (eight total); New York is now one of seven states that provide both IVF and fertility preservation. Laws vary greatly by state—some provide more than three cycles, some less, and some cover different insurance markets, so it does depend on the specific state.